First the good news:

Cancers that come in Childhood are curable if detected early and treated
properly

Contents
1. Remaining positive and hopeful
2. What is Childhood cancer
3. Types of cancer
4. When you are diagnosed
5. The treatment of cancer
6. Possible side effects of cancer treatment
7. Looking after yourself
8. Preventing infections
9. Diet
10. Dietary recommendations
11. After discharge care
12. Frequently asked questions
13. Simple Recipes for you
14. What some of the kids told me and acknowledgements

Remaining positive and hopeful

The best thing in life is to always remain positive and hopeful.

1. Be normal: Cancer is just another disease like other diseases, we all

get .
2. Talk: Always ask questions. Ask your parents, ask the doctor . If you
feel scared don’t worry. It is normal to feel anxious. Do not hide your
anxiety. Do not be stressed.
3. Keep the mind active: Do activities as much as you can. Learn new
skills or learn a new music instrument. Read. Keep your brain active
and stimulated
4. Keep the body active: If you are feeling well, play in a clean and dust
free environment and get some fresh air.
5. Be flexible: During treatment and on some days, when you do not
feel well or want to perform other activities, then relax at home.
6. Eat well: Eat small frequent meals and meals you like.
7. Pray/Sing: Often if releases stress and gives positive energy if you
pray or sing together as a family.
CHILDHOOD CANCER
Cancer in childhood can affect any part of the body. The most commonly
affected are blood, muscles, bones and organs.
Childhood cancers do not act like, treated like or respond like adult
cancers. Do not compare adult cancers with childhood cancers.
Cancer is not contagious. It does not pass by contact or from person to
person.

What is cancer
The human body has millions of cells. These cells divide and form new cells
which replace the old cells. The normal cell division allows the different
organs in the body to function and is guided by the genetic code or the
DNA of each cell.
Cancer is a term used for a group of diseases, where cells divide
abnormally without control because of a defective genetic code. When too
many abnormal cells are made in an organ, it interferes with other parts of
the body working properly. Cancer cells can invade other parts of the body
through blood and lymph systems. When cancerous cells are made and
collect in one place a lump or tumour can be formed.

TYPES OF CANCER
WHAT CAUSES CANCER?

While in some adult cancers, the cause is known, most childhood cancers
have no known cause. Childhood cancers can occur suddenly and without
early symptoms.

Cancer is no one’s fault so you are not at fault.

There are two main types of cancer-

1. Blood cancer
Leukamia is a type of blood cancer where the white blood cells in the
bone marrow divide too quickly. The bone marrow is the soft part of the
center of our long and flat bones. In Leukamia, the bone marrow gets so
clogged up with unhealthy blood cells there is no room for healthy
blood cells to grow.

Lymphoma is a type of blood cancer where the white blood cells in the
lymph nodes divide too quickly. The lymph nodes are an important part
of the body’s immune system. In lymphoma the lymph nodes , liver or
spleen get enlarged and stop functioning normally.
2. Solid tumours
When cancerous cells clump together they form a tumour. Tumours can
grow in any part of the body. They tend to destroy the surrounding
healthy organs and this is dangerous. Cells in these tumours are
abnormal and divide without control or order.
Tumours can also be non cancerous and are called benign. They can
often be removed and in most cases don’t come back. Cells from
benign tumours don’t spread to other parts of the body. Most
importantly they are not life threatening.

WHEN YOU ARE DIAGNOSED.

Staging of cancer.
After your cancer has been diagnosed a few tests are done to help
identify the specific type of cancer. This is called confirmatory testing.
After this some more tests are done to determine how much the cancer
is and where the location is. This is called staging.

To stage solid tumours the doctor looks at the size of tumour, the lymph
nodes affected and where it has spread.

To stage lymphoma, the doctor checks the lymph nodes, bone marrow,
liver, spleen, lung, and the rest of the body around the cancer site.
Some Special tests such as genetic testing of tumours may also be
carried out to assess the curability of cancer.

Primary and secondary cancer

The primary cancer is where the cancer started. If some of the cancer
cells break away from the primary cancer site and settle in another part
of the body this cancer is called a secondary cancer or metastases. The
cancer cells can spread locally by entering the blood stream or the
lymphatic system. Secondary cancers are made up of the same type of
cells as primary cancer.

Cancer that has spread is called Metastatic cancer.

There are 3 main types of treatment for cancer- surgery, chemotherapy

and radiation therapy.

The type or combination of treatment used depends on the type of

cancer the child has. The doctor will advise you on which treatment is
the best option.
 The 3 main types of cancer treatment:
1. Surgery
The tumour is physically removed by an operation.

2. Chemotherapy
Medical drugs are used to slow or stop the growth of cancer cells .
These drugs are given by
1. IV drip : injection into a vein
2. Oral: as tablets or capsules
3. IM (intramuscular) : injection into the muscle
4. Subcutaneous: injection just under the skin
5. Intrathecal: by lumbar puncture

These chemotherapy drugs travel through the blood stream and they reach
and destroy cancer cells all over the body. Therefore chemotherapy is very
useful in treating cancers that have spread all over like blood cancer.
These drugs kill the cancer cells but also the good cells. The healthy cells
repair themselves over a period of time. However they need time to
recover , so chemotherapy is given as a series of treatment called cycles
which are normally separated by a few weeks.
Chemotherapy drugs can cause side effects. And because you are young,
your side effects are normally low.

3. Radiation therapy
High doses of radiation is given to stop the cancer from spreading or
growing.
Radiation is an invisible treatment where high energy rays from a machine
are used to destroy the cancer cells in one part of the body. This treatment
is given in daily sessions at the hospital. Each session is for 15-20 mins. The
overall length of time of treatment depends on the type of tumour and can
be for 2-6 weeks.
Unfortunately, radiation kills some healthy cells as well as cancer cells, and
this causes some side effects like fatigue, skin change and loss of apetitite .

POSSIBLE SIDE EFFECTS OF CANCER TREATMENT

Nausea and vomiting
These may start immediately after chemotherapy or happen several days
later. These effects last from hours to weeks. Medication is given to
decrease the nausea and vomiting.
Diarrhea
This may develop at any time after chemotherapy and is usually due to one
of the two reasons
• The chemotherapy drug may affect the intestines.
• Unhygenic food consumed during the period of chemotherapy. (like
fast food, coconut water or other food from the roadside vendors)

Sores and ulcers in the mouth and throat

These effects start in a few days after chemotherapy. It is important that you
brush your teeth atleast 2-3 times every day. If you get any pain in the
mouth or ulcers, please inform your parents and ask them to speak to the
doctors.

Constipation
This can happen because of drugs given to stop vomiting. However
sometimes the chemotherapy drugs can also cause this. If you do not pass
a stool for 3 days it is constipation.
Also if you see blood in your stool or have belly cramps or bloating for all
this you must tell the doctor immediately.

Hair loss
• Don’t worry if you lose some or all your hair during treatment, It will
all come back in 4-6 months so just wear a cap or a scarf .

Low white blood cell count (Leukopenia) with or without infection

• This complication starts 4-6 days after the start of chemo and lasts
for a few days. Low WBC counts may or may not be associated with
infection. The first sign of infection is fever (>38 C) . If you feel hot or
uncomfortable please tell your parents to call the doctor.

Low platelet count

Platelets create red blood cells in our body and also clot blood if we get a
wound or cut.
Chemotherapy drugs can result in low platelet counts and it will take 2-3
weeks for the platelets to become normal again.
During this period make sure you don’t get a cut, or wound. So be careful
even if you are playing.

Anemia
This is low haemoglobin count in the body and again is a side effect of
chemotherapy drugs. This happens after many cycles of chemotherapy.
The symptoms of anemia are weakness, fatigue, palpitations, shortness of
breath, poor concentration etc. Have lots of good fruits , vegetables, have
star fruit, red dragon fruit and beets and carrots as they improve
haemoglobin. Also the doctor can give vitamins so please have them.

LOOKING AFTER YOURSELF.

Cancer can create low WBC and this can result in low neutrophils which
are part of the WBC. A shortage of this is called neutropenia. This means
infections can come.

Basic precautions to take to prevent contracting an infection

1. Wear a mask
2. Avoid crowds
3. Avoid people with fever , colds, boils
4. Avoid children who have been recently immunized.

Signs of infection
Fever is a sign of infection and you should ask your parents to take you to a
doctor immediately.

Other common indications of infection

• Chills, shivering, sweating
• Loose motions
• Sore throat, or cough
• Burning during urination
• Redness in the skin or genital area

Temperature checking
You can take your temperature under your arms or through the mouth.
• Use a clean thermometer and do not touch the bulb. Keep a daily
recording of the temperature taken at the same time everyday.

Taking the temperature in the mouth

• Make sure you have not eaten or drunk anything for 15 mins before
the temperature is taken as this can give an incorrect reading.
• Disinfect the bulb and stem of the thermometer with an antiseptic
solution like Dettol. Wipe it dry.
• Insert the bulb end of the thermometer under your tongue towards
the side of the mouth and hold for one minute.
 • Keep a daily record of the temperature taken at the same time
everyday.

PREVENTING INFECTIONS
Hand hygiene
1. Wash hands with antiseptic soap each time after using the toilet, and
before eating food.
2. Wash your hands often during the day especially when you come
from outside , before you eat, and before and after you use the
toilet.

Dental hygiene
1. Please brush your teeth two times every day, before breakfast and
after dinner. If blood counts are low, then you should clean with a
finger to avoid bleeding.
2. Gargle with a mouthwash at least 3-4 times a day after every meal to
prevent mouth ulcers and infections. Hold the mouth wash for 30
seconds and spit out.

Body hygiene
1. Please bathe two times a day and wear clean cotton clothes
2. After using the toilet wash your hands with soap and water
3. Clean any cuts immediately with water, soap and an antiseptic
4. Use a lotion or oil to soften and heal your skin if it becomes dry and
cracked

If you have loose motion

1. Take a sitz bath 2-3 times a day.
2. Do not rub the perinatal areas otherwise the skin will become painful
and ulcerate.
3. Allow the area to dry and use a zinc ointment

Ask your mother to do this Procedure for Sitz bath

1. Take half a tub of warm water
2. Add 2 caps of 10% betadine solution
3. Then you sit in the water bath for 15 minutes
4. After this have a normal bath

Nails and hair

Keep your nails short . If your hair is falling, shave off completely. Do this
only if the blood counts are normal. Ensure that the blade used is new

Playing
Please wear a face mask to prevent infection
Please change the mask twice a day with new clean mask
Avoid sports and other activities that can cause injuries

Lung health
To prevent lung infections, avoid going to crowded, dusty areas and
construction sites
Steam inhalation should be done twice a day
Don’t go near anyone who is smoking or anyone who is unwell
Always wear a face mask
Don’t meet too many and ensure they wear a face mask also.

Clean living space

It is very important to keep the living and bed area clean. Sheets should be
changed often. Toilets and bathrooms should be cleaned with antiseptic
Floors should be mopped with Antiseptic also, two times every day.
Nets should be on doors and windows to avoid any flies and insects.

All food stuffs should be covered.

DIET
This is most important during treatment and helps in recovery.
When recovering from cancer, you should have a low bacteria diet. This
reduces the chances of any infection and helps you heal faster.

Things to remember

1. Drink liquids
2. Drink only boiled and clean water.
3. Do not eat raw food like raw vegetables. Eat only cooked food.
4. Eat only fruits where the skin can be cut or peeled like bananas,
mango, and dragon fruit.
5. Do not eat any street vendor food.

Washing fruits and vegetables

Use vinegar: take a cup of vinegar and 3 cups of boiled water, add a
teaspoon of baking soda and make a solution. Please store this carefully in
a big bottle. First use this to wash any fruit then wash again with plain
boiled water.

DIET DURING CHEMOTHERAPY:

Food is a necessary part of treatment.
There is no special diet to follow. Everyone whether they have cancer or
not should have a well balanced diet with good protein and calories.
You should have extra calories and more protein and lots of minerals and
vitamin rich foods.
All fruits have anti oxidants and vitamins and minerals so they are good.
Add gula merah and not white sugar because gula merah has lots of iron.
During chemotherapy you must have lots of liquids and water. It is very
good to have pocari, and other bottled juices. You can also have bottled
ice tea. This will reduce the side effects of chemotherapy.

Eat small frequent meals.

1. Eat 6- 8 times a day but small portions
2. If you have a bad taste in the mouth have a mint tea or ginger ale.
3. Don’t lie flat after eating. Sit in a chair for sometime and watch TV or
listen to music

Have a balanced diet, eat fruits, eat chicken boiled not fried, have
vegetables stir fried like spinach, beans, sprouts, boiled eggs, omelettes,
rice

Have milk and yogurt (but only good yogurt from supermarkets)
You can also eat small pieces of cheese, noodles .

You must have red, yellow, orange coloured fruits and vegetables in your
diet.

Eat protein rich foods

1. Milk , yogurt, cheese is good
2. Tempe and Tofu is very good
3. Chicken, beef, lamb . You can have satay made at home and made
with little oil.
 4. Ask your mother not to use the same oil for frying. Use fresh oil each
time for frying.

To increase haemoglobin and potassium

1. Kurma
2. Spinach
3. All green vegetables
4. Dragon fruit
5. Star fruit
6. Mangostein
7. Banana
8. Gula merah is very good also . The darker the better.
9. Sweet potato
10. Potatoes

Avoid
1. Fried, greasy , very spicy foods
2. Extra sweet foods like chocolates
3. Avoid very high fibre foods like corn, dried beans, cabbage, peas,
cauliflower as they can cause cramping and diarrhea

DIETARY RECOMMENDATIONS

Beverages
Yes
1. boiled and cooled water
2. Pocari
3. Other packaged juices
4. Boiled milk
5. Don’t add extra sugar to your drinks as this can cause diarrhea.

No
1. unboiled milk
2. No ice
3. No fruit juice from street side vendors

Cereals
Yes
1. Rice, noodles, Oats
2. Wheat bread
3. Home made cakes, cookies
No
1. cakes with cream
2. No left over or reheated food
3. No bakery products from street side

Fruits
Yes
1. Banana, Orange, water melon
2. Papaya, Mango, mangostein
3. Dragon fruit, apples

No
1. angoor
2. rambutan

Vegetables
All vegetables should be cooked

Do not eat any raw or uncooked vegetables

Milk and Milk products

Yes
1. boiled milk
2. Cheese
3. Formula packaged
4. Yogurt
No
1. Raw milk
2. Ice creams
3. No street side taro or other milk drinks
Nuts and dried fruits
Yes
1. Kurma
2. Peanuts – roasted and cooked at home

No
1. raw peanuts
2. Raw soya nuts

Spices
Yes to all spices.
If you have constipation
1. Drink plenty of fluids
2. Warm and hot fluids are good
3. Fruit juices
4. Cooked raisins
5. Whole wheat bread
6. Kurma
7. Popcorn
8. Oats

If you feel fullness in your stomach:

1. eat small portions
2. Eat only 1-2 hours after or before chemotherapy
3. Don’t eat any oily and greasy foods
4. Don’t have gas producing foods like cabbage, water melons,
cucumber, onions or beans.
5. Don’t have late meals. Eat before 6 pm every day.

Eat slowly, chew well

Wear loose fitting clothes.

If you have a sore mouth

1. use a straw to drink
2. Consume milk and thick yogurt shakes
3. Eat soft foods like rice, biscuts and bread soaked in milk, pasta,
boiled potato, pudding, jelly,custard, eggs, banana,
4. Mix 2-3 spoons of protein powder
Don’t eat acidic food or spicy food.
Acidic food is made with vinegar and with soya sauce. Avoid this.

To avoid muscle loss because of chemotherapy

1. Eat cheese, soups, meat
2. Eggs
3. Powdered milk and breakfast drinks
4. Flavoured yogurt
5. Increase protein in diet.
6. Have kurma and roasted peanuts

AFTER DISCHARGE CARE

1. Continue to eat the same kind of food for atleast 6 months till you
gain your full strength and the doctor completely cures you
 2. Remember to take your medicines for the period the doctor has
advised you
3. Do blood tests often
4. Keep visiting the doctor on the days he has asked you to see him.

Most important – enjoy life and be normal again.

FREQUENTLY ASKED QUESTIONS

1. Does sugar feed cancer?

Answer: There is no scientific proof that proves that sugar makes cancer
cells grow. It is true that cancer cells have a need for sugar as well as
other nutrients like all other cells. If you avoid all good sugar then you
will starve the healthy cells as well which will result in malnutrition
Avoid refined sugar like soda, candy, and get sugar from fruits, kurma,
gula merah which have vitamins and minerals that will build your
immune system

2. Do processed meats cause cancer?

Answer: Processed meats like sausages where preservatives have been
added are not good. When meats are smoked they absorb chemicals
called tars and this can cause cancer. So avoid eating processed meats.

3. what is pasteurization in milk?

Pasteurization or heat treatment involves heating milk to very high
temperatures and this kills harmful bacteria that can cause illness. But if
the milk is kept for long, then the milk will spoil after a few days.
Therefore always keep milk in the fridge after you open it.

4. Do kiwi/papaya increase platelets?

Answer: all fruits have antioxidants and minerals that are good and
improve haemoglobin and platelets. Food that is rich in iron like gula
marah , citrus fruits like orange, lemon increase haemoglobin if it is
because of low iron. But in cancer treatment, if the haemoglobin falls
below 7-8 gms or platelets are below 20,000/cmm, then we need blood
or platelet transfusion.

Few recipes for you to tell mom to make

Oats for breakfast

Ingredients
 1. boiled oats 30 gms
2. Milk 125 ml
3. Nutrition powder ( whey powder) – 2 tablespoons
4. Coconut oil -3 teaspoons
5. Salt- to taste

Method:
Boil oats with milk, add whey powder, coconut oil. And salt and have
it hot
Add grated gula merah on top for taste.

Enriched coconut milk

1. Rice flour- 30 g
2. Gula merah- 25 g
3. Coconut milk- 200 ml

Roast the rice flour,

Dissolve the gula merah in coconut milk
Add the roasted rice to gula merah
Boil and cool and have as a drink or like a soup.

Sweet eggs
1. Milk -200 ml
2. Eggs-2
3. Sugar – 50 gms (better to have with brown sugar)

Blend egg and milk

Add sugar and boil with continuous stirring

Peanut butter and Jam sandwich

1. 2 slices bread
2. 2 tablespoons peanut butter
3. 1 teaspoon Jam

Put the peanut butter first on both slices, then spread jam on the top of
each slice. Close the 2 slices to make a sandwich. Enjoy with a glass of
Dancow Milk.

Avocado and Melon smoothie

1 ripe, fresh Avocado*

1 cup melon chunks (about 1 slice)
Juice from ½ lime (1 ½ tsp. lime juice)

1 cup milk,
1 cup yogurt, plain
½ cup apple juice
1 Tbsp. honey

Method
1. Cut avocado in half, remove pit.
2. Scoop out flesh, place in blender.
3. Add remaining ingredients; blend well and drink

Also can you add 3 recipes – how to make a quick stir fried kankung and
maybe a egg dish